Pub Date : 2025-10-01Epub Date: 2025-05-15DOI: 10.1016/j.jpag.2025.05.002
Lauren A. Bell MD, MPH , Elizabeth I. Harrison MD, MS , Traci M. Kazmerski MD, MS , Margaret R. Russell MD , Tahniat Syed MD, MPH , Nicholas Szoko MD, PhD , Crystal P. Tyler PhD, MPH , Laura A. Kirkpatrick MD
Study Objective
This study sought to formulate a model of the process through which adolescents and young adults (AYAs) progress when making decisions around pregnancy.
Methods
We recruited United States-based participants aged 18-35 years in 2020-2021 who experienced pregnancy under age 20 across 3 pregnancy outcomes (parenting, adoption, abortion). Through semi-structured phone interviews, we explored participants’ emotions around pregnancy, pregnancy disclosures, and pregnancy-related decision-making. We used qualitative analysis to identify common themes in the steps of the process experienced by participants in their decision-making and associated influences and develop a model of that process.
Results
We interviewed 50 participants aged 13-19 years at the time of 1 or more pregnancies, totaling 56 pregnancies (16 parenting, 19 abortions, 18 adoptions, and 3 miscarriages). The developed Pregnancy Decision-making and Outcome Trajectories (PDOT) model incorporates varied trajectories of intention establishment/achievement. PDOT has 4 stages: 1) initial reactions, 2) intention analysis, 3) planning, and 4) action/inaction. PDOT highlights AYA potential to experience persistent uncertainty around pregnancy but also potential to express certainty and move toward thoughtful research, support-seeking, and cost/benefit analysis. PDOT also highlights the impact of barriers and facilitators that limit AYAs from or help AYAs with achieving their desired pregnancy outcome.
Conclusion
Pregnant AYAs experience difficulty making and following through with decisions around pregnancy outcomes. People interfacing with pregnant AYAs can utilize this framework to give AYAs appropriate, intentional support to boost AYA agency in making decisions around pregnancy and acting on those decisions.
{"title":"A Developmentally-Informed Model of Adolescent Decision-Making Around Pregnancy: A Qualitative Study","authors":"Lauren A. Bell MD, MPH , Elizabeth I. Harrison MD, MS , Traci M. Kazmerski MD, MS , Margaret R. Russell MD , Tahniat Syed MD, MPH , Nicholas Szoko MD, PhD , Crystal P. Tyler PhD, MPH , Laura A. Kirkpatrick MD","doi":"10.1016/j.jpag.2025.05.002","DOIUrl":"10.1016/j.jpag.2025.05.002","url":null,"abstract":"<div><h3>Study Objective</h3><div>This study sought to formulate a model of the process through which adolescents and young adults (AYAs) progress when making decisions around pregnancy.</div></div><div><h3>Methods</h3><div><span>We recruited United States-based participants aged 18-35 years in 2020-2021 who experienced pregnancy under age 20 across 3 pregnancy outcomes (parenting, adoption, abortion). Through semi-structured phone interviews, we explored participants’ emotions around pregnancy, pregnancy </span>disclosures, and pregnancy-related decision-making. We used qualitative analysis to identify common themes in the steps of the process experienced by participants in their decision-making and associated influences and develop a model of that process.</div></div><div><h3>Results</h3><div>We interviewed 50 participants aged 13-19 years at the time of 1 or more pregnancies, totaling 56 pregnancies (16 parenting, 19 abortions, 18 adoptions, and 3 miscarriages). The developed Pregnancy Decision-making and Outcome Trajectories (PDOT) model incorporates varied trajectories of intention establishment/achievement. PDOT has 4 stages: 1) initial reactions, 2) intention analysis, 3) planning, and 4) action/inaction. PDOT highlights AYA potential to experience persistent uncertainty around pregnancy but also potential to express certainty and move toward thoughtful research, support-seeking, and cost/benefit analysis. PDOT also highlights the impact of barriers and facilitators that limit AYAs from or help AYAs with achieving their desired pregnancy outcome.</div></div><div><h3>Conclusion</h3><div>Pregnant AYAs experience difficulty making and following through with decisions around pregnancy outcomes. People interfacing with pregnant AYAs can utilize this framework to give AYAs appropriate, intentional support to boost AYA agency in making decisions around pregnancy and acting on those decisions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 607-615"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-04-14DOI: 10.1016/j.jpag.2025.04.005
Sarah A. Golub MD, MPH , Alissa Roberts MD , Colleen McCarty MPH , Erin Sullivan MPH , Sahar N. Rooholamini MD, MPH , Taraneh Shafii MD, MPH
Objective
To understand the scope of sexual and reproductive health (SRH) services provided to adolescents assigned female at birth in pediatric hospitals in the United States.
Methods
Data were collected via an electronic survey of inpatient clinical leaders at freestanding and nested children’s hospitals in the United States. Survey domains included availability of trained clinicians, equipment to perform pelvic exams, contraceptive methods offered, and facilitators and barriers in providing SRH services. Descriptive statistics were used for analysis.
Results
Of 160 invited hospitals, 52 (33%) responded with 25 (48%) surveys completed by Pediatric Hospital Medicine and 23 (44%) Adolescent Medicine specialists. Twenty-two (42%) worked in free-standing and 30 (58%) in nested children’s hospitals with 42 (81%) reporting academic- or university-affiliations. Only 3 (6%) reported having the equipment needed to perform pelvic exams on the inpatient unit. Eleven (21%) reported providing some form of long-acting reversible contraception, of which all provided implants; only 5 (10%) institutions offered intrauterine device insertion. A common facilitator was having clinicians with required skills (65%) and a common barrier was SRH not being considered an inpatient problem (83%).
Conclusion
While clinicians identify SRH services at children’s hospitals as important, many lack the basic equipment needed and institutional support to provide comprehensive SRH care. This study suggests that the integration of clinicians appropriately trained in SRH care may be one of the greatest facilitators to providing inpatient SRH care in children’s hospitals.
{"title":"Availability of Inpatient Sexual and Reproductive Health Services at U.S. Children’s Hospitals","authors":"Sarah A. Golub MD, MPH , Alissa Roberts MD , Colleen McCarty MPH , Erin Sullivan MPH , Sahar N. Rooholamini MD, MPH , Taraneh Shafii MD, MPH","doi":"10.1016/j.jpag.2025.04.005","DOIUrl":"10.1016/j.jpag.2025.04.005","url":null,"abstract":"<div><h3>Objective</h3><div><span>To understand the scope of sexual and reproductive health (SRH) services provided to adolescents assigned female at birth in </span>pediatric hospitals in the United States.</div></div><div><h3>Methods</h3><div>Data were collected via an electronic survey of inpatient clinical leaders at freestanding and nested children’s hospitals in the United States. Survey domains included availability of trained clinicians, equipment to perform pelvic exams, contraceptive methods offered, and facilitators and barriers in providing SRH services. Descriptive statistics were used for analysis.</div></div><div><h3>Results</h3><div>Of 160 invited hospitals, 52 (33%) responded with 25 (48%) surveys completed by Pediatric Hospital Medicine and 23 (44%) Adolescent Medicine specialists. Twenty-two (42%) worked in free-standing and 30 (58%) in nested children’s hospitals with 42 (81%) reporting academic- or university-affiliations. Only 3 (6%) reported having the equipment needed to perform pelvic exams on the inpatient unit. Eleven (21%) reported providing some form of long-acting reversible contraception, of which all provided implants; only 5 (10%) institutions offered intrauterine device insertion. A common facilitator was having clinicians with required skills (65%) and a common barrier was SRH not being considered an inpatient problem (83%).</div></div><div><h3>Conclusion</h3><div>While clinicians identify SRH services at children’s hospitals as important, many lack the basic equipment needed and institutional support to provide comprehensive SRH care. This study suggests that the integration of clinicians appropriately trained in SRH care may be one of the greatest facilitators to providing inpatient SRH care in children’s hospitals.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 572-577"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-03-10DOI: 10.1016/j.jpag.2025.03.003
Siyu Zhou MD , Bregje C.D. van Uden MD , Margot Smets MD , Lisa Kamperdijk MD , Jiexin Tang MD , Hristiyanna I. Ivanova MSc , Joost Daams MA , Theodorus B. Twickler MD, PhD , Tanja G.M. Vrijkotte PhD
Purpose
This systematic review aims to identify, assess the quality of, and synthesize evidence on nongenetic maternal factors, such as psychological factors, lifestyle, nutrition, and endocrine conditions that may be associated with pubertal timing in male and female offspring.
Methods
The search was conducted in Medline, Embase, PsycInfo and Web of Science. The reference lists of retrieved articles were checked to avoid missing relevant studies. There were no restrictions on publication year or language. The quality of the studies was assessed using the Newcastle–Ottawa Scale. This review has been registered on PROSPERO (CRD42023394102). A best-evidence approach was applied to qualitatively summarize the findings and draw conclusions on the level of evidence.
Results
The search yielded 4199 studies, of which 73 were included in this systematic review. In both boys and girls, there is strong evidence of a positive association between maternal gestational weight gain and an earlier pubertal timing, while no association was found with maternal substance use, thyroid dysfunction, or gestational hypertension. In addition, there is insufficient evidence of an association with maternal psychological factors, smoking, diet, physical activity, prepregnancy weight/body mass index, diabetes, menstruation-related disorders, and steroid medication use.
Conclusion
This review provides a comprehensive overview of the quality and consistency of existing evidence regarding maternal factors during pregnancy that may be associated with the pubertal timing in their offspring. This review may serve as an orientation for future research initiatives, with a particular focus on exploring these associations among male offspring and in low- and middle-income countries.
目的：本系统综述旨在识别、评估和综合非遗传母体因素的证据质量，如心理因素、生活方式、营养和内分泌条件，这些因素可能与男性和女性后代的青春期发育时间有关。方法：在Medline、Embase、PsycInfo、Web of Science中进行检索。检查检索文献的参考文献列表，避免遗漏相关研究。对出版年份和语言没有限制。研究的质量采用纽卡斯尔-渥太华量表进行评估。本综述已在PROSPERO注册（CRD42023394102）。采用最佳证据方法对研究结果进行定性总结，并就证据水平得出结论。结果：检索得到4199项研究，其中73项纳入本系统综述。在男孩和女孩中，有强有力的证据表明母亲妊娠期体重增加与青春期提前之间存在正相关，而与母亲药物使用、甲状腺功能障碍或妊娠期高血压没有关联。此外，没有足够的证据表明与产妇心理因素、吸烟、饮食、体育活动、孕前体重/体重指数、糖尿病、月经相关疾病和类固醇药物使用有关。结论：这篇综述提供了关于怀孕期间母亲因素可能与后代青春期时间相关的现有证据的质量和一致性的全面概述。这篇综述可以作为未来研究计划的方向，特别侧重于探索男性后代和中低收入国家的这些关联。
{"title":"Maternal Factors During Pregnancy and Pubertal Timing in Offspring: A Systematic Review of the Literature","authors":"Siyu Zhou MD , Bregje C.D. van Uden MD , Margot Smets MD , Lisa Kamperdijk MD , Jiexin Tang MD , Hristiyanna I. Ivanova MSc , Joost Daams MA , Theodorus B. Twickler MD, PhD , Tanja G.M. Vrijkotte PhD","doi":"10.1016/j.jpag.2025.03.003","DOIUrl":"10.1016/j.jpag.2025.03.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review aims to identify, assess the quality of, and synthesize evidence on nongenetic maternal factors, such as psychological factors, lifestyle, nutrition, and endocrine conditions that may be associated with pubertal timing in male and female offspring.</div></div><div><h3>Methods</h3><div>The search was conducted in Medline, Embase, PsycInfo and Web of Science. The reference lists of retrieved articles were checked to avoid missing relevant studies. There were no restrictions on publication year or language. The quality of the studies was assessed using the Newcastle–Ottawa Scale. This review has been registered on PROSPERO (CRD42023394102). A best-evidence approach was applied to qualitatively summarize the findings and draw conclusions on the level of evidence.</div></div><div><h3>Results</h3><div>The search yielded 4199 studies, of which 73 were included in this systematic review. In both boys and girls, there is strong evidence of a positive association between maternal gestational weight gain and an earlier pubertal timing, while no association was found with maternal substance use, thyroid dysfunction, or gestational hypertension. In addition, there is insufficient evidence of an association with maternal psychological factors, smoking, diet, physical activity, prepregnancy weight/body mass index, diabetes, menstruation-related disorders, and steroid medication use.</div></div><div><h3>Conclusion</h3><div>This review provides a comprehensive overview of the quality and consistency of existing evidence regarding maternal factors during pregnancy that may be associated with the pubertal timing in their offspring. This review may serve as an orientation for future research initiatives, with a particular focus on exploring these associations among male offspring and in low- and middle-income countries.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 541-553"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-09-13DOI: 10.1016/j.jpag.2025.09.001
{"title":"Who You Gonna Trust? Your Doctor or Social Media?","authors":"","doi":"10.1016/j.jpag.2025.09.001","DOIUrl":"10.1016/j.jpag.2025.09.001","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 539-540"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-04-30DOI: 10.1016/j.jpag.2025.04.008
Taylore King MD , Cynthia Abam MD , Emily Trautner MD , Elissa Trieu MD , Laura Ramirez-Caban MD
Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome involves Müllerian abnormalities including agenesis of the upper vagina. Patients often elect for the creation of a neovagina, which can be performed via intestinal vaginoplasty to allow for penetrative sexual intercourse. We present a case of a 38-year-old female with MRKH who underwent sigmoid vaginoplasty and presented 12 years later with diffuse neovaginal closure, resulting in pelvic abscess formation and sepsis. She ultimately required surgical excision of the sigmoid neovagina for source control of the infection. This case highlights the importance of lifelong aftercare following vaginoplasty and incorporation of multidisciplinary teams in medically complex patients with complications from neovagina reconstruction.
{"title":"Stenosis of Sigmoid Neovagina with Subsequent Pelvic Infection and Surgical Excision","authors":"Taylore King MD , Cynthia Abam MD , Emily Trautner MD , Elissa Trieu MD , Laura Ramirez-Caban MD","doi":"10.1016/j.jpag.2025.04.008","DOIUrl":"10.1016/j.jpag.2025.04.008","url":null,"abstract":"<div><div><span>Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome involves Müllerian abnormalities including agenesis<span> of the upper vagina. Patients often elect for the creation of a neovagina, which can be performed via intestinal vaginoplasty to allow for </span></span>penetrative sexual intercourse<span><span>. We present a case of a 38-year-old female with MRKH who underwent sigmoid vaginoplasty and presented 12 years later with diffuse neovaginal closure, resulting in </span>pelvic abscess formation and sepsis. She ultimately required surgical excision of the sigmoid neovagina for source control of the infection. This case highlights the importance of lifelong aftercare following vaginoplasty and incorporation of multidisciplinary teams in medically complex patients with complications from neovagina reconstruction.</span></div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 640-643"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-04-04DOI: 10.1016/j.jpag.2025.03.007
Andrea J. Hoopes MD, MPH , Alina Metje MD, MPH , Creagh Miller MPH , Charissa M. Tomlinson BA , Thang D. Dao BS , Marlaine Figueroa Gray PhD
Purpose
To understand how patient portals can support adolescent sexual and reproductive health (SRH) care needs and to identify factors impacting use of patient portals for adolescent-clinician communication.
Methods
We conducted semi-structured interviews with adolescents, parents/guardians, and primary care providers (PCPs) by video or phone. Interview guides explored experiences with adolescent healthcare-seeking generally and SRH care specifically, as well as perspectives regarding adolescent portal use. Interviews were recorded, transcribed, and deidentified. Interviewer summaries written after each interview noted key themes that informed analysis. The analysis team collaboratively coded transcripts. Codes were synthesized into analytic memos, which were refined to develop results.
Results
We interviewed 31 people from 1 health system: 10 adolescents 14-17 years old and 10 parents/guardians of adolescents aged 14-17, and 11 primary care providers (PCPs). A motivator of portal use shared by all participants included convenience of use. Clinicians and parents/guardians also viewed portals as a tool to support adolescent independence and improve quality of care. Barriers shared by all participants included lack of adolescent portal uptake and dissatisfaction with functionality. Clinicians and adolescents raised concerns about confidentiality while parents and clinicians raised concerns about safety of care. Supports shared by all participants included encouragement and guidance from trusted adults, while adolescents and clinicians described the reinforcing nature of positive care experiences using the portal.
Discussion
Through the perspectives of adolescents, parents/guardians, and clinicians, we elucidated key factors that may influence adolescent portal use for SRH care needs. We identified critical intervention targets for future research.
{"title":"“Really Hard to Navigate”: A Qualitative Study of Motivators, Barriers, and Supports of Adolescent-Clinician Communication on Patient Portals","authors":"Andrea J. Hoopes MD, MPH , Alina Metje MD, MPH , Creagh Miller MPH , Charissa M. Tomlinson BA , Thang D. Dao BS , Marlaine Figueroa Gray PhD","doi":"10.1016/j.jpag.2025.03.007","DOIUrl":"10.1016/j.jpag.2025.03.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To understand how patient portals can support adolescent sexual and reproductive health (SRH) care needs and to identify factors impacting use of patient portals for adolescent-clinician communication.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with adolescents, parents/guardians, and primary care providers (PCPs) by video or phone. Interview guides explored experiences with adolescent healthcare-seeking generally and SRH care specifically, as well as perspectives regarding adolescent portal use. Interviews were recorded, transcribed, and deidentified. Interviewer summaries written after each interview noted key themes that informed analysis. The analysis team collaboratively coded transcripts. Codes were synthesized into analytic memos, which were refined to develop results.</div></div><div><h3>Results</h3><div>We interviewed 31 people from 1 health system<span>: 10 adolescents 14-17 years old and 10 parents/guardians of adolescents aged 14-17, and 11 primary care providers (PCPs). A motivator of portal use shared by all participants included convenience of use. Clinicians and parents/guardians also viewed portals as a tool to support adolescent independence and improve quality of care. Barriers shared by all participants included lack of adolescent portal uptake and dissatisfaction with functionality. Clinicians and adolescents raised concerns about confidentiality while parents and clinicians raised concerns about safety of care. Supports shared by all participants included encouragement and guidance from trusted adults, while adolescents and clinicians described the reinforcing nature of positive care experiences using the portal.</span></div></div><div><h3>Discussion</h3><div>Through the perspectives of adolescents, parents/guardians, and clinicians, we elucidated key factors that may influence adolescent portal use for SRH care needs. We identified critical intervention targets for future research.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 554-561"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-06-09DOI: 10.1016/j.jpag.2025.06.001
Jessy Epstein MD , Simrat Veera DO , John Pappas MD , Bina Cherryl Shah MD
Background
Primary ovarian insufficiency (POI) is ovarian dysfunction that leads to suboptimal estrogen production and irregular or absent menses. Many causes of POI are idiopathic. Genetic testing may help identify novel causes of POI.
Case presentation
An adolescent female presented with primary ovarian insufficiency. Her hormonal workup was significant for hypergonadotropic hypogonadism. She was found to have a likely pathogenic variant in the MTPAP gene on whole exome sequencing. This nuclear gene encodes a polymerase that affects mitochondrial mRNA degradation.
Conclusion
Ovarian tissue is highly reliant on mitochondria for steroidogenesis. A genetic variant that affects mitochondrial function, such as the one in our patient, is likely to have profound effects on ovarian function. We hypothesize that this patient's variant in the MTPAP gene caused POI.
{"title":"A Case Report of Primary Ovarian Failure in an Adolescent Associated With a Homozygous Pathogenic Variant in the Mitochondrial Poly-A-Polymerase Gene (MTPAP)","authors":"Jessy Epstein MD , Simrat Veera DO , John Pappas MD , Bina Cherryl Shah MD","doi":"10.1016/j.jpag.2025.06.001","DOIUrl":"10.1016/j.jpag.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div><span>Primary ovarian insufficiency (POI) is </span>ovarian dysfunction<span> that leads to suboptimal estrogen production and irregular or absent menses. Many causes of POI are idiopathic. Genetic testing may help identify novel causes of POI.</span></div></div><div><h3>Case presentation</h3><div><span>An adolescent female presented with primary ovarian insufficiency. Her hormonal workup was significant for hypergonadotropic hypogonadism. She was found to have a likely pathogenic variant in the </span><span><span>MTPAP</span></span><span><span> gene on whole exome sequencing. This nuclear gene encodes a </span>polymerase that affects mitochondrial mRNA degradation.</span></div></div><div><h3>Conclusion</h3><div><span><span>Ovarian tissue is highly reliant on mitochondria for steroidogenesis. A </span>genetic variant<span> that affects mitochondrial function, such as the one in our patient, is likely to have profound effects on ovarian function. We hypothesize that this patient's variant in the </span></span><em>MTPAP</em> gene caused POI.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 637-639"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-04-17DOI: 10.1016/j.jpag.2025.04.006
Christopher Garrick , Benjamin Bear MSW , Meghan Gannon PhD, MSPH , Anne E. Kazak PhD, ABPP , Julia Eisenberg MD , Yasaman Alibabaee , Beth I. Schwartz MD
Study Objective
Menses in transgender or gender-diverse people can cause dysphoria, which has been linked to various comorbid conditions including depression, anxiety, and suicidal ideation. Although social support is thought to be beneficial for adolescents in general, little is known about its effects on gender-diverse adolescents (GDAs) receiving care. Thus, this study sought to document the effects of social support on the menses management experiences for GDAs and highlight how such support influences their access to and satisfaction with gender-affirming care.
Methods
Participants were recruited from a tertiary care children’s hospital to participate in semi-structured phone interviews. Eligibility included adolescents who were 12-20 years of age and had undergone menarche. Interviewers asked respondents about the impact of menses on their mental health, relationships, daily activities, and experiences with menses management and suppression.
Results
A total of 36 individuals participated, with a mean age of 16.82 (SD 2.02) years. Six major themes were identified related to social support: Types of Support, Support Persons within the Social Network, School Environment, Medical Providers as a Social Support, Resources, and Advice for Others.
Conclusion
This study highlights the vital role of social support as GDAs navigate gender-affirming care and menses management. The exploration of various sources of support—such as family, peers, and health care providers—emphasizes the importance of safe, affirming environments for GDAs. Clinicians as perceived support have a unique opportunity to foster shared decision-making and health advocacy by using preferred pronouns, recognizing dysphoria triggers, and considering GDAs’ perspectives when developing care plans.
{"title":"Social Support Related to Menses in Gender-Diverse Adolescents: A Qualitative Study","authors":"Christopher Garrick , Benjamin Bear MSW , Meghan Gannon PhD, MSPH , Anne E. Kazak PhD, ABPP , Julia Eisenberg MD , Yasaman Alibabaee , Beth I. Schwartz MD","doi":"10.1016/j.jpag.2025.04.006","DOIUrl":"10.1016/j.jpag.2025.04.006","url":null,"abstract":"<div><h3>Study Objective</h3><div>Menses in transgender or gender-diverse people can cause dysphoria, which has been linked to various comorbid conditions including depression, anxiety, and suicidal ideation. Although social support is thought to be beneficial for adolescents in general, little is known about its effects on gender-diverse adolescents (GDAs) receiving care. Thus, this study sought to document the effects of social support on the menses management experiences for GDAs and highlight how such support influences their access to and satisfaction with gender-affirming care.</div></div><div><h3>Methods</h3><div>Participants were recruited from a tertiary care children’s hospital to participate in semi-structured phone interviews. Eligibility included adolescents who were 12-20 years of age and had undergone menarche. Interviewers asked respondents about the impact of menses on their mental health, relationships, daily activities, and experiences with menses management and suppression.</div></div><div><h3>Results</h3><div>A total of 36 individuals participated, with a mean age of 16.82 (SD 2.02) years. Six major themes were identified related to social support: Types of Support, Support Persons within the Social Network, School Environment, Medical Providers as a Social Support, Resources, and Advice for Others.</div></div><div><h3>Conclusion</h3><div>This study highlights the vital role of social support as GDAs navigate gender-affirming care and menses management. The exploration of various sources of support—such as family, peers, and health care providers—emphasizes the importance of safe, affirming environments for GDAs. Clinicians as perceived support have a unique opportunity to foster shared decision-making and health advocacy by using preferred pronouns, recognizing dysphoria triggers, and considering GDAs’ perspectives when developing care plans.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 585-591"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-05-01DOI: 10.1016/j.jpag.2025.04.003
Katherine C. Bergus MD, MPH , Brenna Rachwal MPH , Lindsey Asti PhD, MPH , Lesley L. Breech MD , Yuan Yuan Gong MD , S. Paige Hertweck MD , Holly R. Hoefgen MD , Anne H. Horne MSN, RN, CPN , Ashli Lawson MD MS , Seema Menon MD , Kathleen E. O’Brien MD , Shashwati Pradhan MD , Yolanda R. Smith MD , Priya Suvarna , Sarah Van Son MD , Geri Hewitt MD
Study Objective
This multi-institutional, observational, retrospective cohort study aimed to characterize the demographics and preoperative medical management of patients with pathology-confirmed endometriosis.
Methods
We reviewed patients <22 years at 8 tertiary care pediatric hospitals in the Midwestern United States who underwent diagnostic laparoscopy and had biopsy-confirmed endometriosis. Patients were identified through pathology records. Demographics, medical history, clinical symptoms, and prior medical management were extracted. Descriptive statistics were computed.
Results
Among 305 patients, median age at first presentation to pediatric and adolescent gynecology (PAG) was 15.6 years (interquartile range: 14.2-17.1). Most patients were White (83.3%) and most had commercial insurance (70.5%). Only 4.3% had a diagnosis of endometriosis prior to their initial presentation to PAG. Common symptoms included progressive dysmenorrhea (76.7%), heavy menstrual bleeding (50.8%), missed school/activities due to dysmenorrhea (55.1%). Patients sought care for their symptoms from a range of providers in addition to PAG, including primary care/adolescent medicine (75.1%), gastroenterology (18.7%), adult gynecology (22.3%), and physical therapy (13.4%). Nearly all patients (92.8%) tried oral hormonal menstrual suppression prior to laparoscopy. Hormonal management included combined oral contraception (62.3%), medroxyprogesterone acetate injection (15.7%), ≤5mg daily norethindrone (14.8%), >5mg daily norethindrone (13.4%), hormonal intrauterine system (13.1%), and contraceptive implant (5.3%).
Conclusions
Patients with pathology-proven endometriosis typically presented with progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding. They sought care from a variety of providers and while most tried hormonal management of symptoms, the method used varied.
{"title":"Characteristics and Preoperative Management of Adolescent Patients with Pathology-Confirmed Endometriosis: A Multi-Institutional Study","authors":"Katherine C. Bergus MD, MPH , Brenna Rachwal MPH , Lindsey Asti PhD, MPH , Lesley L. Breech MD , Yuan Yuan Gong MD , S. Paige Hertweck MD , Holly R. Hoefgen MD , Anne H. Horne MSN, RN, CPN , Ashli Lawson MD MS , Seema Menon MD , Kathleen E. O’Brien MD , Shashwati Pradhan MD , Yolanda R. Smith MD , Priya Suvarna , Sarah Van Son MD , Geri Hewitt MD","doi":"10.1016/j.jpag.2025.04.003","DOIUrl":"10.1016/j.jpag.2025.04.003","url":null,"abstract":"<div><h3>Study Objective</h3><div><span>This multi-institutional, observational, retrospective cohort study aimed to characterize the demographics and preoperative medical management of patients with pathology-confirmed </span>endometriosis.</div></div><div><h3>Methods</h3><div>We reviewed patients <22 years at 8 tertiary care pediatric<span> hospitals in the Midwestern United States who underwent diagnostic laparoscopy and had biopsy-confirmed endometriosis. Patients were identified through pathology records. Demographics, medical history, clinical symptoms, and prior medical management were extracted. Descriptive statistics were computed.</span></div></div><div><h3>Results</h3><div><span>Among 305 patients, median age at first presentation to pediatric and adolescent gynecology<span> (PAG) was 15.6 years (interquartile range: 14.2-17.1). Most patients were White (83.3%) and most had commercial insurance (70.5%). Only 4.3% had a diagnosis of endometriosis prior to their initial presentation to PAG. Common symptoms included progressive dysmenorrhea<span><span><span> (76.7%), heavy menstrual bleeding (50.8%), missed school/activities due to dysmenorrhea (55.1%). Patients sought care for their symptoms from a range of providers in addition to PAG, including primary care/adolescent medicine (75.1%), </span>gastroenterology<span> (18.7%), adult gynecology (22.3%), and physical therapy (13.4%). Nearly all patients (92.8%) tried oral hormonal menstrual suppression prior to laparoscopy. Hormonal management included combined </span></span>oral contraception (62.3%), medroxyprogesterone acetate injection (15.7%), ≤5mg daily </span></span></span>norethindrone<span> (14.8%), >5mg daily norethindrone (13.4%), hormonal intrauterine system (13.1%), and contraceptive implant (5.3%).</span></div></div><div><h3>Conclusions</h3><div>Patients with pathology-proven endometriosis typically presented with progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding. They sought care from a variety of providers and while most tried hormonal management of symptoms, the method used varied.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 5","pages":"Pages 629-636"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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